Provider Demographics
NPI:1982966867
Name:BURKETT, MAX ANDREW (NP)
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:ANDREW
Last Name:BURKETT
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3287 MALCOLM DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-8816
Mailing Address - Country:US
Mailing Address - Phone:334-356-9970
Mailing Address - Fax:334-356-9873
Practice Address - Street 1:3287 MALCOLM DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-8816
Practice Address - Country:US
Practice Address - Phone:334-356-9970
Practice Address - Fax:334-356-9873
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-054443363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily